Anatomy of

The Urinary Bladder

&
The urethra

Presented by
Mohammad Ihmeidan PGY2
 The urinary bladder
 a hollow distensible muscular organ
 situated in the pelvic cavity posterior to the
symphysis pubis.
 In infants and children , it is situated higher.
 When it is full, it rises above the symphysis and
can readily be palpated or percussed.
 Full bladder
 Capacity 400 -700 cc
 Ovoid shape.

 Empty bladder
The empty bladder is shaped
like a threesided pyramid.
 It has an apex, a base,
a superior surface, and two
inferolateral surfaces.
The apex of the bladder
is attached to a structure known as the median umbilical
ligament (a remnant of the embryologic urachus)
 The urachus anchors the bladder to the anterior
abdominal wall
 There is a relative paucity of bladder wall muscle at
point of attachment of urachus, predisposing to
diverticula formation
 Near umbilicus, becomes more fibrous and fuses with
one of the obliterated umbilical arteries
 Superior Surface
 Covered by peritoneum.
 Anteriorly, the peritoneum sweeps gently onto the anterior
abdominal wall
 With distention, the bladder rises out of the true pelvis and
separates the peritoneum from the anterior abdominal wall.
 It is therefore possible to perform a suprapubic
cystostomy without risking entry into the peritoneal cavity.
 Posteriorly, the peritoneum passes to the level of the
seminal vesicles and meets the peritoneum on the anterior
rectum to form the rectovesical space
The base of the bladder is shaped like an inverted
triangle and faces posteroinferiorly.
The two ureters enter the bladder at each of the upper
corners of the base and the urethra drains inferiorly
from the lower corner of the base.
• The smooth triangular
area between the
openings of the ureters
and urethra on the
inside of the bladder
Is known as the trigone
The intravesical ureteral
orifices are roughly 2-3
cm apart. The
intramural ureters are
each about 1.5 cm in
length.
 Inferolateral
 Anteroinferiorly and laterally, the bladder is
cushioned from the pelvic side wall by
retropubic and perivesical fat and loose
connective tissue.
 Base and Neck
 In males the bladder base is related to the seminal vesicles,
ampullae of the vas deferens , and terminal ureter.

 The bladder neck, located at the internal urethral meatus,

rests 3-4 cm behind symphysis pubis
 It is firmly fixed by the pelvic fasciae and by its continuity
with the prostate
 In females ,the vagina and uterus intervene between
the bladder and the rectum so that the base of the bladder
and urethra rest on the anterior vaginal wall
The mucosa of the urinary bladder is lined by a
multilayered transitional epithelium (urothelium).
Beneath it ,is a submucosal layer formed of
connective and elastic tissues

External to the submucosa is the detrusor muscle

the detrusor muscle which is made up of a mixture of
smooth muscle fibers arranged at random in a
longitudinal, circular, and spiral manner
When becomes close to the internal meatus, where the
detrusor muscle assumes 3 definite layers:
Inner longitudinal, middle circular, and outer
longitudinal.
 circular smooth muscle fibers form internal urethral
sphincter
 circular skeletal muscle fibers form external urethral
sphincter
 adventitia layer of loose connective tissue anchors in place
 superior surface has serosal layer (visceral peritoneum)
 Bladder Circulation
 The arterial blood supply of the bladder arrives
primarily from superior vesicle branches,middle
vesical and inferior vesical arteries which arise
from the anterior trunk of the internal iliac
(hypogastric)artery

 The arterial supply of the bladder is also derived

in part from the obturator artery and inferior
gluteal artery. In females, this is via
the uterine artery and vaginal artery.
 Venous:
 Surrounding the bladder is a rich plexus of veins
 that ultimately empties into the internal iliac
(hypogastric) veins

 Lymphatics:
 The lymphatic drainage of the bladder is into the
obturator, external iliac, internal iliac
(hypogastric), and common iliac lymph nodes but
the bulk of bladder lymph goes into internal iliac
L.N
 The urethra
 The urethra is a fibromuscular tube that conducts
urine from the bladder (and semen from the
ductus deferens) to the exterior. It begins at the
neck of the bladder
 and ends at the external urethral orifice.
 Differs significantly in women and men.
 In females
 The urethra is short, being about 4 cm long.
 It travels a slightly curved course as it passes inferiorly through
the pelvic floor into the perineum, where it passes through the
deep perineal pouch and perineal membrane before opening in
the vestibule that lies between the labia minora ;between the
clitoris and the vagina.
 In males
 The urethra is longer than females, about 20 cm
 Beginning at the base of the bladder
 passing inferiorly through the prostate,
it passes through the deep
perineal pouch and perineal
membrane and enters the root
of the penis.
 The urethra exits the deep perineal
pouch, it bends forward to course anteriorly
in the root of the penis.
.
 When the penis is flaccid, the urethra
makes another bend, this time
inferiorly, when passing from the root
to the body of the penis.

 During erection, the bend between

the root and body of the penis
disappears
The urethra in men is divided into:
 preprostatic,
 prostatic,
 membranous, and
 spongy (penile) parts.
Preprostatic part Prostatic part
• The preprostatic part of the
• The prostatic part of the
urethra is about 1 cm long.
• It extends from the base of the
urethra is 3-4 cm long and is
bladder to the prostate, and is surrounded by the prostate.
associated with a circular cuff In this region, the lumen of
of smooth muscle fibers (the the urethra is marked by a
internal urethral sphincter). longitudinal midline fold of
Contraction of this sphincter mucosa (the urethral crest).
prevents retrograde
movement of semen into the
bladder during ejaculation.
Membranous part
• The membranous part of
the urethra is narrow and
passes through the deep
perineal pouch.
• During its transit through
this pouch, the urethra, in
both men and women, is
surrounded by skeletal
muscle of the external
urethral sphincter.
Spongy (Penile) urethra
• The spongy urethra is
surrounded by erectile tissue
(the corpus spongiosum) of
the penis.
• It is enlarged to form a bulb at
the base of the penis and
again at the end of the penis
to form the navicular fossa).
• The external urethral orifice is
the sagittal slit at the end of
the penis.
Thank you